Case report| Volume 62, P222-225, April 2019

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Mycotic intracranial aneurysms rupture presenting as pure acute subdural hematoma in infectious endocarditis. Report of 2 cases and review of the literature

Published:January 09, 2019DOI:


      • Ruptured mycotic aneurysm (MA) manifesting as subdural hematoma (SDH) is extremely rare.
      • In infective endocarditis (IE) MAs may manifest as acute SDH (ASDH).
      • Even rare, MA should be considered as a cause of acute SDH of unknown origin.
      • Necessity to repeat CT-Angiography/MRA in IE associated ASDH, even isolated.


      Acute subdural hematoma (ASDH) revealing mycotic aneurysm (MA) is an exceptional occurrence.
      We report 2 cases of MA-related pure ASDH in the course of infective endocarditis (IE) without history of head trauma, hypertension or coagulopathy.
      Case 1: A 54-year-old man presented with a 10-day history of headache, fever. At admission neurologic examination and Brain-CT were normal. Blood cultures showed Streptococcus bovis. MRI 5 days later revealed ischemic spots and minime ASDH over the right convexity. Cerebral angiography, revealed a 3 mm saccular aneurysm at the bifurcation of a distal branch of the right posterior cerebral artery (PCA).
      Case 2: A 42-year-old man presented with a 8-day history of fever, and worsening headache. Mitral regurgitation was evidenced. A methicillin-sensitive staphylococcus aureus left-sided IE was diagnosed. Pre- and post-contrast Brain-CT were normal. He presented 15 days later a secondarily generalized status epilepticus. Brain CT showed an ASDH over the convexity with falco-tentorial extension, midline shift and temporal herniation. It was removed in emergency. Cerebral angiography revealed a MA of a peripheral branch of the left PCA.
      The 2 patients were successfully treated by endovascular glue embolization and recovered without complications.
      Even rare, ruptured MA should be considered as a cause of pure ASDH of unknown origin.
      As MA can be missed on CT- and MR-Angiography because of mass effect, cerebral angiography may be mandatory.


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